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Y3 Oxford Cases > RIF pain > Flashcards

RIF pain Flashcards

1
Q

Differentials for RIF pain

A 
Appendicitis
Gastroenteritis 
Uteric colic
Inguinal hernia (encarcerated or strangulated)
Epididymitis and/or orchitis 
Mesenteric adenitis 
Acute pancreatitis 
Testicular torsion
Meckel's diverticulitis
Cholecystitis
Pyelonephritis 
Psoas abscess
Bowel obstruction
Constipation
DKA
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2
Q

What differentials should be considered for females with RIF

A 
Ectopic pregnancy 
Pelvic inflammatory disease/salpingitis
Torsion/haemorrhoage/rupture of ovarian tumour or cyst
Mittelschmerz 
Threatened abortion
Fibroid degeneration
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3
Q

What should be looked for on examination

A 
Signs of being ill - febrile, tachycardic, hypotensive, tachypnoeic 
Scars
Abdominal distension
Cervical lymphadenopathy (rule out mesenteric adenitis)
Masses
Bowel sounds
Hernias
Rectal exam
External genitalia (testicular torsion)
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4
Q

What blood tests should be done for RIF

A

FBC: inflammation
CRP: inflammation
VBG: raised lactate, met. acidosos -> ischaemia or sepsis
U+Es: indication for fluids + prognosis
Serum amylase/lipase: mainly pancreatitis
Glucose: DKA + glasgow scoring
Liver enzymes: prognosis for pacnreatitis

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5
Q

How may a urinalysis be beneficial for RIF pain

A

Infection, renal/uteric calculi/retrocaecal appendix - haematuria

DKA - glucose, ketones

UTI - positive leucocyte esterase and nitrites

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6
Q

What imaging would be requested for RIF pain

A

Abdominal USS: renal/biliary pathology, appendicitis, free fluid, gynae problems
Erect CXR: pneumoperitoneum
CT abdomen:
ECG: ? sinus tachy
AXR: bowel obstruction, IBD + toxic megacolon, foreign body

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7
Q

What may cause a perforated viscus and pneumoperitoneum

A

Perforated peptic ulcer
Meckel’s diverticulum
Caecal diverticulum
Appendix

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8
Q

What are the typical features of mesenteric adenitis

A 
Typically follows an URTI or sore throat
Cervical lymphadenopathy may be present 
Common <15 yrs
Pain often diffuse, uncommon to have peritonitis 
Fever often has a higher temperature
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9
Q

What are the typical features of Meckel’s diverticulitis

A

Almost identical to appendicitis

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10
Q

What are the typical features of constipation

A

Hx of infrequent/or absent bowel motions

Does not result in fever or tachycardia

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11
Q

What are the typical features of Crohn’s

A

Hx of diarrhoea and weight loss for week/months up to presentation, which is similar to appendicitis

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12
Q

What are the typical features of Gastroenteritis

A

Vomiting and diarrhoea main symptoms

Symptoms seen in close contacts

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13
Q

What are the typical features of Renal/uteric colic

A

Writhing in pain and would not migrate

Urine dipstick shows haematuria

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14
Q

What are the typical features of pancreatitis

A

Migration atypical and often pain in the epigastric region

Elevated amylase

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15
Q

How is acute appendicitis managed

A 
IV fluid bolus
Analgesia
NBM 
Broad spectrum Abx
DVT prophylaxis e.g. LMWH and Ted stockings
Arrange appendicectomy
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16
Q

What is the sepsis 6

A

Take: lactate, Blood cultures, urine output (for AKI)
Give: high flow oxygen, IV antibiotics, fluid

17
Q

What is appendix mass and how does it present

A

Greater omentum, caecum and/or adherent loops of small bowel wrap around the inflamed appendix
Presents like appendicitis but slightly milder pain

18
Q

What is mittelschmertz syndrome

A

Affects 1 in 5 menstruating women
Relatively mild RIF pain, short-lived and cyclical in nature
Episodes are on different sides each time
Absence of signs on abdominal exam

19
Q

What is the difference between SIRS, sepsis, severe sepsis , septic shock and multiorgan failure

A

Severe inflammatory response syndrome: temp >38 or <36, HR >90, RR >20 or pCO2 <4.3, WCC >12 or <4

Sepsis: SIRS caused by suspected infection

Severe sepsis: sepsis that causes hypotensions and end organ hypoperfusion

Septic shock: severe sepsis that is refractory to fluid resus

Multiorgan dysfunction/failure: evidence of two or more organs failing

20
Q

What are the two incisions used for open appendicectomy

A

Gridiron incision - perpendicular to line between ASIS and umbilicus over Mcburney’s
Lanz - 2cm medial to the ASIS and follows a horizontal course (better cosmesis due to placement in natural skin crease)

21
Q

Why does a surgeon inspect the distal 60cm of the terminal ileum during an operation where a normal appendix is found

A

Check for inflamed/rupture Meckel’s diverticulum
Remnant of the vitelline duct
Occurs in 2% of the population, may contain 2 types of ectopic cells (pancreatic and gastric), situated within 2 feet of the ileocaecal valve

Y3 Oxford Cases (29 decks)

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